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To Your Good Health: Using microwave to reheat food? Pick container carefully

By Keith Roach, M.D.

Posted:
08/01/2014 12:01:00 AM CDT

Updated:
08/01/2014 01:25:10 PM CDT

Q: Recently, you wrote about reheating foods in a microwave and advised against polystyrene or other plastic containers. What is the best kind of container to use in the microwave?

A: Most plastics probably are safe to use when heating liquids. But reheating foods can cause pockets of very high temperatures that can partially melt the plastic and cause the release of potentially harmful chemicals. I recommend using glass or ceramic plates or bowls to reheat food.

Q: My brother had his aortic valve replaced by a mechanical heart valve. He says the warfarin he takes causes him problems -- head pain, stomach pain, nausea and joint and muscle aches and pains. Our family is concerned that he may not be taking the warfarin. I know a few people who also take warfarin and they have no such problems. Are serious side effects common on warfarin?

A: Warfarin (Coumadin) is among the most powerful medicines we use, and it can have life-threatening side effects.

Warfarin, an anticoagulant, works by inhibiting Vitamin K-1, and prevents the body from making several of the proteins involved in blood clotting and regulation.

Warfarin also has the potential to interact with many medications through multiple pathways, and needs careful monitoring. Excess warfarin most commonly causes bleeding, but in some people warfarin can cause paradoxical blood clotting when it is first started.

It would be reasonable to wonder why such a potentially harmful medication is ever used.

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There were 29,000 emergency visits per year due to adverse bleeding events from warfarin, according to one recent study.

The answer is that, as potentially dangerous as warfarin is, there are many situations where not being on warfarin is even worse.

I have written about a common one, atrial fibrillation, where many people with A fib should be on some kind of anticoagulation, most commonly warfarin.

There are some newer alternatives in A fib, such as dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis). Unfortunately, as in your brother's case, there is no good alternative to warfarin for anticoagulation due to a mechanical heart valve.

Mechanical heart valves put people at a very high risk for blood clot and stroke. The risk of a stroke from a serious bleed into the brain is approximately 4 percent per year without anticoagulation, and there is an additional 4 percent per year risk of a blood clot in the lungs or deep veins. Your brother's doctor is quite right: Not taking the medicine is exceedingly dangerous.

Since there isn't a good alternative medication, I don't have any better advice for your brother than to try to find ways to minimize the side effects. For example, stomach pain and nausea often can be managed with diet.

A bioprosthetic heart valve usually doesn't require long-term anticoagulation: People with known poor reaction to warfarin probably should be given this kind of valve, and not mechanical.

Q: Six or seven years ago, after a longstanding runny nose and cough, I had an allergy test. I was told I had nonallergic rhinitis and that there was no treatment. After seeing a new ENT doctor, I had another allergy test. Those results showed I am allergic to many things -- pollen, dust mites, animals, etc. I have been getting five shots per week for more than a year now, and there is no change. My coughing, runny nose, burning and tearing eyes have gotten worse. What do you suggest I do?

A: "Nonallergic rhinitis" is a term given to a group of related medical conditions that share symptoms of sneezing, runny nose, nasal congestion and post-nasal drip.

Eye symptoms are not common in nonallergic rhinitis, and since in hindsight these have become more of a problem, I suspect your second ENT doctor is right, that your condition is allergic.

The symptoms of allergic rhinitis are similar: sneezing, often in groups; runny nose and nasal congestion; but often prominent are eye symptoms, such as watery and itchy eyes. Cough and post-nasal drip also are common.

There is treatment for both allergic and nonallergic rhinitis. In allergic rhinitis, avoiding what you are allergic to is common sense, but it's not always possible.

You write that you are getting immunotherapy shots. I am very surprised you didn't tell me about medication therapy, since there are many different classes of effective medications that are normally tried before going on to immunotherapy.

Like any treatment, including medications, not everyone gets a benefit from immunotherapy. A year usually is long enough to begin seeing benefits, but some people continue to improve up to three and even five years after starting treatment.

The most effective single treatment for allergic rhinitis is a preparation of nasal steroids; however, since there are many, many prescription, nonprescription and complementary and alternative approaches, you need to go back to your doctor and discuss your options and whether to continue the immunotherapy.

One treatment I will highlight that is safe, effective and improves other treatments is irrigation of the nose with saline. This can be done before using other medications to help their absorption.

Q: I have been taking Lipitor for high cholesterol. Recently, my pharmacist mentioned that all statins can cause memory loss. I hesitate to stop taking Lipitor, but I don't want this side effect. What do you advise?

A: Your pharmacist is quite right that some users of statins can have the unwanted side effect of memory loss. But this is quite variable: Some people never get this effect, and it can be quite severe in a few.

It appears to be reversible in the majority of people who get it.

I wouldn't recommend you stop taking Lipitor unless you are having the side effect.